General info

Question 1

Signs & symptoms

Answer 1

• Fever or malaise, aches and pains
• Pus, swelling or inflammation
• Drowsiness in children
• Confusion in elderly
• Worsening renal function.

Question 2

Infection - clinical markers

Answer 2

• Low BP
• Raised blood glucose
• High ESR, CRP, temp, respiratory rate & pulse

Question 3

Antimicrobial stewardship

Answer 3

An organisation or healthcare system wide approach to promoting and monitoring the judicious use of antimicrobials to preserve future effectiveness.

Question 4

AMS - Principles

Answer 4

• Do not treat viral infections with antibiotics
• Avoid blind prescribing
• Narrow spectrum Abx are preferred EXCEPT in the case of serious infection where broad-spectrum is needed.
• Avoid prolonged therapy
• Complete courses
• Follow nation/local prescribing guidelines
• Dose varies according to patient factors.
• Prescribed for oral infections on basis of defined need.

Question 5

Choice of Abx

Answer 5

Depends on:
- Patient
- Causative agent

Question 6

Children

Answer 6

• Tetracyclines contraindicated in <12 years/
• Quinolones cause arthropathy (AVOID)
  arthropathy = joint disease

Question 7

Elderly

Answer 7

Increased risk of C.difficile infection
- Clindamycin = highest risk
- Cephalosporins (ceftriaxone, cefalexin)
- Carbapenems
- Co-amoxiclav

Consider renal/liver impairment and drug interactions.

Question 8

Penicillin allergic

Answer 8

Cross sensitivity with cephalosporins and other b-lactam antibiotics (e.g. carbapenems)
Alternatives:
- Macrolides (erythromycin, clarithromycin, azithromycin)
- Metronidazole in dental infection

Question 9

Renal impairment

Answer 9

Nephrotoxicity
- Aminoglycosides
- Glycopeptide

AVOID
- Tetracyclines (except minocycline/doxycycline)
- Nitrofurantoin (eGFR < 45 mL/min) may be used with caution if eGFR 30–44 mL/ minute/1.73 m2 as a short-course only (3 to 7 days), to treat uncomplicated lower urinary-tract infection caused by suspected or proven multidrug resistant bacteria and only if potential benefit outweighs risk.

Question 10

Hepatic impairment

Answer 10

Hepatoxicity = rifampicin + tetracyclines
Reduce metronidazole dose if severely impaired
Cholestatic jaundice = co-amoxiclav + flucloxacillin

Question 11

Pregnancy

Answer 11

Contraindicated = tetracyclines + trimethoprim
Nitrofurantoin = causes nausea, AVOID at term.

AVOID (MCAT)
- Metronidazole
- Chloramphenicol (neonatal grey-baby syndrome if used in 3rd trimester).
- Aminoglycosides (risk of vestibular nerve damage in 2nd + 3rd trimester, highest risk = streptomycin, low risk = gentamicin + tobramycin but avoid).
- Tetracycline
- Quinolones (arthropathy)
- Sulphonamides (neonatal haemolysis and methaemoglobinaemia in third trimester)

Question 12

Pregnancy - safest Abx

Answer 12

• Penicillin
• Cephalosporins

Question 13

Cautionary and advisory label

Answer 13

Space doses evenly throughout the day and keep taking this medicine until the course is finished, unless you are told to stop

Question 14

GI side effects

Answer 14

• N + V
• Vomiting
• Diarrhoea
• Abdominal pain

Question 15

Superinfection

Answer 15

Clindamycin + broad spectrum abx kill normal flora and allow selective organsims to thrive, causing:
- antibiotic associated colitis (e.difficile)
- thrush (candida) e.g. vaginal thrush

Question 16

Allergic reactions

Answer 16

1 in 15 experience hypersensitivity reactions ESPECIALLY to penicillins and cephalosporins

Question 17

Staphylococci

Answer 17

Flucloxacillin

Question 18

MRSA

Answer 18

Vancomycin

Question 19

Streptococci

Answer 19

Benzylpenicillin or phenoxymethylpenicillin

Question 20

Anaerobic bacteria

Answer 20

Metronidazole

Question 21

Pseudomonas aerguinosa

Answer 21

Gentamicin